Male sling testimonial – Andrew Richards*

“Knowing what I know now, if I had to choose whether or not to have the male sling I would certainly make the same decision. The improvement is really significant and means that the degree of incontinence I have is now something I can live with.”
Andrew Richards*, male sling patient

Andrew Richards* describes his experience of prostate cancer, the incontinence he developed after treatment and subsequently having a male sling fitted

Diagnosis

For a number of years I had been having an annual PSA test always at my instigation rather than my GP’s. A lot of doctors actively discourage the use of this test because it is considered to be unreliable, however in my opinion and until something better comes along it is the only thing we have got at our disposal. Following my test in April 2010 my GP said that the PSA reading was 5.4 and while this was normal for a man of my age (71) it had increased from 2.6 the previous year. He suggested another test in three months time, which unfortunately produced the same result. We both agreed that further investigations were needed and I requested a letter of referral to Mr Alan Doherty of the Birmingham Prostate Clinic. I knew of Mr Doherty from a relative by marriage who had developed Prostate Cancer some three years previously and had been successfully treated by Mr Doherty.

While Mr Doherty was concerned about the sudden change in the PSA value he felt at this stage there was no need to jump straight into a biopsy. As he explained they were somewhat unpleasant and he did not believe in carrying them out unnecessarily. He did however suggest a MRI Scan and a PCA3 Gene test which would give a more personalised prediction of cancer. The gene test gives a prediction on a scale of 1 to 100 and anything above 50 suggests a fifty fifty chance of cancer being present. When my score came back at 70 there was no alternative but to go ahead with the biopsy.

As Mr Doherty predicted the biopsy was a bit unpleasant and slightly painful but on the whole nothing to worry about. Unlike the results which showed cancer in six of the twelve samples taken and strong indications of cancer developing in two more. It was now decision time. The cancer was not too aggressive and I was given a choice of either living with it or having the prostate removed. Apparently my age put me on the borderline. Ten years older and I could leave it, ten years younger and the operation was essential. Both my wife and I agreed it was really a no-brainer, I did not want to live with cancer.

Mr Doherty went on to explain that one of the consequences of the operation was incontinence particularly in the short term. In order to get dry I would need to do pelvic floor exercises five or six times a day. Five percent of people never get completely dry and two percent require further surgery. These seemed pretty good odds to me especially knowing that my relative was completely dry and back to work within three months of the operation. Little did I know that I would be one of the two per cent.

The operation

We arrived at the hospital at 7.00am on Thursday 30 September 2010. After the formalities had been completed, I walked to the theatre at about 10.00am. Lay on the bed, chatted to the theatre staff and woke up several hours later, as predicted, in the intensive care unit. I was drifting in and out of consciousness and in quite a lot of pain although the self administered morphine kept the pain to tolerable levels.

Early next morning I was back in my room and Mr Doherty came to see me, explaining that for reasons beyond his control and entirely unconnected with the cancer, he had been forced to convert from keyhole to open surgery. What he described as a “slight complication” felt a lot more than that from where I was standing or more accurately lying. Neither was it any consolation to know that I was the first person in six years that this had happened to.

Each day the pain became less and I became more active. Eight days after the operation I was discharged from hospital with the catheter still in place. This was on a Friday and the following Monday I had the catheter removed. This was when the problems of incontinence really started, even at night when gravity was playing no part in the process. It is important at this stage to make contact with the District Nurse Service or better still if the local NHS Trust like Birmingham has a specialist continence team. They have been a great help and a very good source of expertise.

Recovery

Over time as the exercises began to take effect I became dry firstly at night and then when I was sitting down. Standing and particularly walking remained a problem. Physically I was making quite good progress with little or no pain. Although it was one of the coldest winters on record I did manage to walk most days. After about eight weeks we went out socially and then away for Christmas. The good news was that the PSA test in January 2011 came back with a figure of 0.01 meaning that the cancer had not spread beyond the prostate. (The October test, which is now an annual event, produced the same result).

I saw Mr Doherty again in May 2011 without any improvement in the incontinence which remained a problem during any sort of activity. He felt that it was too soon to reach any conclusions and that we should give the exercises a few more months and review the situation again in October. During this period, I kept a graph of the leakage by weighing the incontinence pads on a daily basis. Unfortunately no further improvement occurred and Mr Doherty felt that the answer was to have a Male Sling inserted around the urethra. This would make it more difficult for the urine to pass from the bladder, a bit like putting a kink in a hosepipe. Because of my holiday commitments and of course Christmas, it was decided to wait until the New Year.

Male sling

Prior to the operation two diagnostic tests were needed. Firstly a Flexible Cystoscopy, which involved using a camera to look inside the bladder to make sure that there were no obstructions, and secondly a Urodynamics test which measured the way the bladder performed under pressure. Both of these tests confirmed Mr Doherty’s thinking that my condition would be improved by the sling.

The operation was arranged for Tuesday 7 February 2012. Within about three hours of walking to the theatre I was fully awake and back in my room. The catheter was removed early next morning and I was discharged at lunchtime. It is now just under a month since the operation and the initial pain I experienced when sitting down and the extreme soreness has now mainly disappeared.

Now, six weeks after the procedure, things are much improved but not perfect. When I am relatively inactive, such as pottering in the garden, I would say my continence is about 65 to 70 per cent. If I am more active such as playing golf, I would say my continence is around 50 to 60 per cent.

Summary

When trying to assess the benefits of the sling the only information I could find was a brief article on the website of Prostate Cancer Charity. There were numerous publications featuring the female sling which appears to have been around for a considerably longer period of time. The male sling is said to be suitable for people with light to moderate leakage but the problem is that no one defines these limits in quantifiable terms. It would be useful therefore to discuss with the surgeon his experience of this procedure. Such topics as the number carried out, the average percentage improvement, the number who became completely dry and those who showed little or no improvement. Purely for my own satisfaction I regret not having had these conversations with Mr Doherty before the operation. In practice it would have made no difference whatsoever because I was more than happy to go along with his recommendations. For people with severe incontinence there is another procedure available which is the artificial sphincter. This is a mechanical device which requires more extensive surgery and was not considered necessary in my case.

Knowing what I know now, if I had to choose whether or not to have the male sling I would certainly make the same decision. The improvement is really significant and means that the degree of incontinence I have is now something I can live with.

*Andrew Richards is not the patient’s real name as he has asked not to remain anonymous